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Women Responding to Women

President Obama’s HHS Mandate Is Bad for Women’s Health and the Practice of Medicine

Dear Senators Boxer, Murray, and Shaheen:

In a Feb. 7, 2012 Wall St. Journal op-ed, you claimed that President Obama’s HHS mandate, which forces everyone, including religious institutions, to pay for abortifacients, oral contraceptives (OCPs), and sterilizations as mandatory benefits in health insurance policies, was a victory for women’s health. As practicing physicians, we can attest that nothing is further from the truth. President Obama’s mandate is bad for women’s health and for the profession of medicine.

First, birth control is not preventive medical care like breast exams and pap smears performed to prevent a late diagnosis of cancer or immunizations to prevent pneumonia and influenza. A child is not a disease, nor are fertility and pregnancy. They are physiological states of healthy individuals.

Second, OCPs contribute to significant disease and dysfunction, such as increased rates of blood clots, strokes, and heart attacks (especially in smokers); increased rates of HPV transmission; and increased incidence of cervical cancer and liver tumors. The same synthetic hormones in OCPs that make a woman’s body behave as if pregnant all the time also change her body chemistry, rendering her more susceptible to STIs. As physicians, we frequently must care [for] women suffering from the unanticipated side effects of OCPs.

OCPs can lower the incidence of ovarian cancer. But only 1 in 72 women will develop ovarian cancer. Of greater concern should be the many studies showing that OCPs increase the risk of breast cancer—especially in young women who use them for more than 4 years before their first full-term pregnancy—since breast cancer rates have increased from 1 in 12 (in 1960 when the pill was first introduced) to 1 in 8 fifty years later. The International Agency for Research on Carcinogens declared estrogen and progesterone Class I carcinogens in 2005. Why would we promote any substance which increases the risk of cancer, and describe it as preventive care?

With regard to “cost savings” in health care, the Guttmacher Institute’s own data show that increases in contraception use lead to increased demand for abortions, and that women are more likely to have unplanned pregnancies when using contraception. There are no valid statistics demonstrating that use of contraception and abortion have improved the health of women and children. In fact, the rates of premature and low birth weight infants have been rising precipitously since rates of abortion and OCP use have increased. One in 8 babies is now born prematurely. NICU care now accounts for 25% of the entire maternal/newborn budget!

Finally, it is important to realize that mandating “free contraception” is not free—it will mean higher insurance premiums for everyone and/or less money for the treatment of real diseases.

A President who is willing to use the power of the federal government to violate the rights of religious freedom, conscientious objection, and free speech of thousands of religious institutions, and of many other Americans who object to this mandate on grounds of conscience, will also have no qualms about ordering physicians to participate in providing contraception, sterilization, and abortion even if it violates their ethical and professional judgment. In gutting the conscience protection rule enacted in 2008, and in refusing to include clear protections for conscience in PPACA, the Obama administration has demonstrated its hostility to the conscience rights of health-care professionals. Attempted coercion in this area will drive out of medical practice many physicians who take their ethical obligations and the Hippocratic Oath seriously. If this happens, millions of women will lose access to physicians who share their beliefs, and all patients will be more at the mercy of future government dictates about what health-care services can be offered or not.

As Catholic physicians, we swear before God to serve the sick with competence, compassion, and charity, always to their benefit and never to their harm. Abortifacients, OCPs, and sterilization do not belong in a preventive services mandate because they are not preventive medicine and not good for women’s health. President Obama’s mandate will prove harmful to women’s health and to the practice of medicine. It must be rescinded immediately.